Perioperative treatment progress of Parkinson’s disease with hip fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XING Fei , LI Lang , LIU Ming , DUAN Xin , LONG Ye ,  XIANG Zhou

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

XIANG Zhou, Email: xiangzhou15@hotmail.com

Keywords：

Parkinson’s disease; hip fracture; perioperative period; internal fixation; arthroplasty

DOI：

10.7507/1002-1892.201801133

Video：

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Objective To review the progress of perioperative treatments for patients of Parkinson’s disease and hip fractures. Methods The related literature of treatments for patients of Parkinson’s disease and hip fractures were reviewed and analyzed from the aspects such as the perioperative management, selection of operation ways, and prognosis. Results The patients of Parkinson’s disease are more likely to sustain hip fractures because of postural instability and osteoporosis. The perioperative treatments for patients of Parkinson’s disease and hip fractures should be determined by orthopedists, neurologist, anesthesiologist, and physical therapist. There is still controversy about the selection of operation and surgical approach. And the prognosis of patients of Parkinson’s disease and hip fractures are associated with the severity of Parkinson’s disease. Conclusion There are few clinical studies about the patients of Parkinson’s disease and hip fractures. The mid-term and long-term functional outcomes of patients of Parkinson’s disease and hip fractures are unsufficient. And the best treatments of patients of Parkinson’s disease and hip fractures need to be further explored.

Citation： XING Fei, LI Lang, LIU Ming, DUAN Xin, LONG Ye, XIANG Zhou. Perioperative treatment progress of Parkinson’s disease with hip fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(8): 1032-1037. doi: 10.7507/1002-1892.201801133 Copy

1.	Chehade MJ, Carbone T, Awward D, et al. Influence of fracture stability on early patient mortality and reoperation after pertrochanteric and intertrochanteric hip fractures. J Orthop Trauma, 2015, 29(12): 538-543.
2.	Chen YY, Cheng PY, Wu SL, et al. Parkinson’s disease and risk of hip fracture: an 8-year follow-up study in Taiwan. Parkinsonism Relat Disord, 2012, 18(5): 506-509.
3.	Nussbaum RL, Ellis CE. Alzheimer’s disease and Parkinson’s disease. N Engl J Med, 2003, 348(14): 1356-1364.
4.	Crego-Vita D, Sanchez-Perez C, Gomez-Rico JA, et al. Intracapsular hip fractures in the elderly. Do we know what is important? Injury, 2017, 48(3): 695-700.
5.	Bloem BR, Grimbergen YA, Cramer M, et al. Prospective assessment of falls in Parkinson’s disease. J Neurol, 2001, 248(11): 950-958.
6.	Williams DR, Watt HC, Lees AJ. Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study. J Neurol Neurosurg Psychiatry, 2006, 77(4): 468-473.
7.	Melton LJ 3rd, Leibson CL, Achenbach SJ, et al. Fracture risk after the diagnosis of Parkinson’s disease: Influence of concomitant dementia. Mov Disord, 2006, 21(9): 1361-1367.
8.	Rothermel JE, Garcia A. Treatment of hip fractures in patients with Parkinson’s syndrome on levodopa therapy. J Bone Joint Surg (Am), 1972, 54(6): 1251-1254.
9.	Song IU, Kim JS, Lee SB, et al. The relationship between low bone mineral density and Parkinson’s disease in a Korean population. J Clin Neurosci, 2009, 16(6): 807-809.
10.	李奇, 杨文平, 孔程程, 等. 帕金森病患者骨密度和血清 25-羟维生素 D 浓度的研究. 南京医科大学学报 (自然科学版), 2016, 36(8): 995-997.
11.	Lam K, Li M, Mok V, et al. A case control study on bone mineral density in Chinese patients with Parkinson’s disease. Parkinsonism Relat Disord, 2010, 16(7): 471-474.
12.	Taylor BC, Schreiner PJ, Stone KL, et al. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Society, 2004, 52(9): 1479-1486.
13.	祁寒梅, 王思婷, 张爱森, 等. 运用骨小梁分数 (TBS) 技术评价帕金森病患者骨质量的变化. 中国骨质疏松杂志, 2016, 22(11): 1409-1412, 1417.
14.	Harris-Hayes M, Willis AW, Klein SE, et al. Relative mortality in U.S. medicare beneficiaries with Parkinson disease and hip and pelvic fractures. J Bone Joint Surg (Am), 2014, 96(4): e27.
15.	Stübig T, Mommsen P, Krettek C, et al. Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs. Unfallchirurg, 2010, 113(11): 923-930.
16.	Kannus P, Parkkari J, Niemi S, et al. Prevention of hip fracture in elderly people with use of a hip protector. New Engl J Med, 2000, 343(21): 1506-1513.
17.	Resch S, Thorngren KG. Preoperative traction for hip fracture: a randomized comparison between skin and skeletal traction in 78 patients. Acta Orthop Scand, 1998, 69(3): 277-279.
18.	Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev, 2004, (4): CD000521.
19.	杨轶, 张弛, 邵云潮, 等. 人工髋关节置换术治疗股骨颈骨折合并帕金森病的疗效. 中华关节外科杂志 (电子版), 2012, 6(4): 16-18.
20.	Starr PA, Vitek JL, Bakay RA. Ablative surgery and deep brain stimulation for Parkinson’s disease. Neurosurgery, 1999, 43(5): 989-1015.
21.	Rascol O, Fitzer-Attas CJ, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson’s disease (the ADAGIO study): prespecified and post-hoc analyses of the need for additional therapies, changes in UPDRS scores, and non-motor outcomes. Lancet Neurol, 2011, 10(5): 415-423.
22.	Aita JF. Why patients with Parkinson’s disease fall. JAMA, 1982, 247(4): 515-516.
23.	Khan I, Jawaid A, Ahmad K, et al. Hip fragility fractures: Anaemia, calcium and vitamin D supplementation. J Pak Med Assoc, 2015, 65(11 Suppl 3): S55-58.
24.	No authors listed. Supplementation with vitamin D3 and calcium prevents hip fractures in elderly women. Nutr Rev, 1993, 51(6): 183-185.
25.	Prince RL, Devine A, Dhaliwal SS, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med, 2006, 166(8): 869-875.
26.	Eventov I, Moreno M, Geller E, et al. Hip fractures in patients with Parkinson’s syndrome. J Trauma, 1983, 23(2): 98-101.
27.	Coughlin L, Templeton J. Hip fractures in patients with Parkinson’s disease. Clin Orthop Relat Res, 1980, (148): 192-195.
28.	Turcotte R, Godin C, Duchesne R, et al. Hip fractures and Parkinson’s disease. A clinical review of 94 fractures treated surgically. Clin Orthop Relat Res, 1990, (256): 132-136.
29.	Londos E, Nilsson LT, Strömqvist B. Internal fixation of femoral neck fractures in Parkinson’s disease 32 patients followed for 2 years. Acta Orthop Scand, 1989, 60(6): 682-685.
30.	Staeheli JW, Frassica FJ, Sim FH. Prosthetic replacement of the femoral head for fracture of the femoral neck in patients who have Parkinson disease. J Bone Joint Surg (Am), 1988, 70(4): 565-568.
31.	van den Bekerom MP, Hilverdink EF, Sierevelt IN, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg (Br), 2010, 92(10): 1422-1428.
32.	Keating JF, Grant A, Masson M, et al. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg (Am), 2006, 88(2): 249-260.
33.	Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg (Am), 2012, 94(7): 577-583.
34.	DeWal H, Su E, DiCesare PE. Instability following total hip arthroplasty. Am J Orthop (Belle Mead NJ), 2003, 32(8): 377-382.
35.	庄泽, 曾春, 曾花, 等. 双极人工股骨头治疗老年帕金森患者股骨颈骨折. 中国组织工程研究, 2012, 16(30): 5534-5539.
36.	周义钦, 忻慰, 周琦, 等. 全髋关节置换术治疗髋部疾病合并帕金森病的早期临床评估. 中华关节外科杂志 (电子版), 2014, 8(6): 736-740.
37.	罗文峰, 赵德伟, 王本杰, 等. 双极人工股骨头置换术治疗帕金森患者股骨颈骨折. 中国矫形外科杂志, 2013, 21(10): 1029-1032.
38.	Lyell V, Henderson E, Devine M, et al. Assessment and management of fracture risk in patients with Parkinson’s disease. Age & Ageing, 2015, 44(1): 34-41.
39.	Agrawal P, Gaba S, Das S, et al. Dynamic hip screw versus proximal femur locking compression plate in intertrochanteric femur fractures (AO 31A1 and 31A2): A prospective randomized study. J Nat Sci Biol Med, 2017, 8(1): 87-93.
40.	Zhong B, Zhang Y, Zhang C, et al. A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures. Orthop Traumatol Surg Res Otsr, 2014, 100(6): 663-668.
41.	Mardani-Kivi M, Mirbolook A, Khajeh Jahromi S, et al. Fixation of intertrochanteric fractures: dynamic hip screw versus locking compression plate. Trauma Mon, 2013, 18(2): 67-70.
42.	Dhamangaonkar AC, Joshi D, Goregaonkar AB, et al. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures. J Orthop Surg (Hong Kong), 2013, 21(3): 317-322.
43.	Huang SG, Chen B, Zhang Y, et al. Comparison of the clinical effectiveness of PFNA, PFLCP, and DHS in treatment of unstable intertrochanteric femoral fracture. Am J Ther, 2017, 24(6): e659-e666.
44.	Jonnes C, Sm S, Najimudeen S. Type Ⅱ intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Arch Bone Jt Surg, 2016, 4(1): 23-28.
45.	张吉斌, 张朝春. 老年股骨粗隆间骨折合并帕金森病患者围手术期治疗. 中国矫形外科杂志, 2011, 19(24): 2058-2060.
46.	李晔, 张保中, 高鹏, 等. 合并帕金森病股骨转子间骨折的手术治疗. 中华骨与关节外科杂志, 2013, 6(4): 361-364.
47.	Kim Y, Moon JK, Hwang KT, et al. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in octogenarians. Acta Orthop Traumatol Turc, 2014, 48(4): 424-430.
48.	Parker MJ, Anand JK. What is the true mortality of hip fractures? Public Health, 1991, 105(6): 443-446.
49.	Burns A, Younger J, Morris J, et al. Outcomes following hip fracture surgery: a 2-year prospective study. Am J Geriatr Psychiatry, 2014, 22(8): 838-844.
50.	Yuasa T, Maezawa K, Nozawa M, et al. Surgical outcome for hip fractures in patients with and without Parkinson’s disease. J Orthop Surg, 2013, 21(2): 151-153.
51.	Weber M, Cabanela ME, Sim FH, et al. Total hip replacement in patients with Parkinson’s disease. Int Orthop, 2002, 26(2): 66-68.
52.	Karadsheh MS, Rodriguez EK, Harris MB, et al. Mortality and revision surgery are increased in patients with Parkinson’s disease and fractures of the femoral neck. Clin Orthop Relat Res, 2015, 473(10): 3272-3279.
53.	Jónsson B, Sernbo I, Johnell O. Rehabilitation of hip fracture patients with Parkinson’s Disease. Scand J Rehabil Med, 1995, 27(4): 227-230.
54.	Bliemel C, Oberkircher L, Eschbach DA, et al. Impact of Parkinson’s disease on the acute care treatment and medium-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg, 2015, 135(11): 1519-1526.
55.	Enemark M, Midttun M, Winge K. Evaluating outcomes for older patients with Parkinson’s disease or dementia with lewy bodies who have been hospitalised for hip fracture surgery: potential impact of drug administration. Drugs Aging, 2017, 34(5): 387-392.
56.	Zuckerman LM. Parkinson’s disease and the orthopaedic patient. J Am Acad Orthop Surg, 2009, 17(1): 48-55.

1. Chehade MJ, Carbone T, Awward D, et al. Influence of fracture stability on early patient mortality and reoperation after pertrochanteric and intertrochanteric hip fractures. J Orthop Trauma, 2015, 29(12): 538-543.
2. Chen YY, Cheng PY, Wu SL, et al. Parkinson’s disease and risk of hip fracture: an 8-year follow-up study in Taiwan. Parkinsonism Relat Disord, 2012, 18(5): 506-509.
3. Nussbaum RL, Ellis CE. Alzheimer’s disease and Parkinson’s disease. N Engl J Med, 2003, 348(14): 1356-1364.
4. Crego-Vita D, Sanchez-Perez C, Gomez-Rico JA, et al. Intracapsular hip fractures in the elderly. Do we know what is important? Injury, 2017, 48(3): 695-700.
5. Bloem BR, Grimbergen YA, Cramer M, et al. Prospective assessment of falls in Parkinson’s disease. J Neurol, 2001, 248(11): 950-958.
6. Williams DR, Watt HC, Lees AJ. Predictors of falls and fractures in bradykinetic rigid syndromes: a retrospective study. J Neurol Neurosurg Psychiatry, 2006, 77(4): 468-473.
7. Melton LJ 3rd, Leibson CL, Achenbach SJ, et al. Fracture risk after the diagnosis of Parkinson’s disease: Influence of concomitant dementia. Mov Disord, 2006, 21(9): 1361-1367.
8. Rothermel JE, Garcia A. Treatment of hip fractures in patients with Parkinson’s syndrome on levodopa therapy. J Bone Joint Surg (Am), 1972, 54(6): 1251-1254.
9. Song IU, Kim JS, Lee SB, et al. The relationship between low bone mineral density and Parkinson’s disease in a Korean population. J Clin Neurosci, 2009, 16(6): 807-809.
10. 李奇, 杨文平, 孔程程, 等. 帕金森病患者骨密度和血清 25-羟维生素 D 浓度的研究. 南京医科大学学报 (自然科学版), 2016, 36(8): 995-997.
11. Lam K, Li M, Mok V, et al. A case control study on bone mineral density in Chinese patients with Parkinson’s disease. Parkinsonism Relat Disord, 2010, 16(7): 471-474.
12. Taylor BC, Schreiner PJ, Stone KL, et al. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Society, 2004, 52(9): 1479-1486.
13. 祁寒梅, 王思婷, 张爱森, 等. 运用骨小梁分数 (TBS) 技术评价帕金森病患者骨质量的变化. 中国骨质疏松杂志, 2016, 22(11): 1409-1412, 1417.
14. Harris-Hayes M, Willis AW, Klein SE, et al. Relative mortality in U.S. medicare beneficiaries with Parkinson disease and hip and pelvic fractures. J Bone Joint Surg (Am), 2014, 96(4): e27.
15. Stübig T, Mommsen P, Krettek C, et al. Comparison of early total care (ETC) and damage control orthopedics (DCO) in the treatment of multiple trauma with femoral shaft fractures: benefit and costs. Unfallchirurg, 2010, 113(11): 923-930.
16. Kannus P, Parkkari J, Niemi S, et al. Prevention of hip fracture in elderly people with use of a hip protector. New Engl J Med, 2000, 343(21): 1506-1513.
17. Resch S, Thorngren KG. Preoperative traction for hip fracture: a randomized comparison between skin and skeletal traction in 78 patients. Acta Orthop Scand, 1998, 69(3): 277-279.
18. Parker MJ, Handoll HH, Griffiths R. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev, 2004, (4): CD000521.
19. 杨轶, 张弛, 邵云潮, 等. 人工髋关节置换术治疗股骨颈骨折合并帕金森病的疗效. 中华关节外科杂志 (电子版), 2012, 6(4): 16-18.
20. Starr PA, Vitek JL, Bakay RA. Ablative surgery and deep brain stimulation for Parkinson’s disease. Neurosurgery, 1999, 43(5): 989-1015.
21. Rascol O, Fitzer-Attas CJ, Hauser R, et al. A double-blind, delayed-start trial of rasagiline in Parkinson’s disease (the ADAGIO study): prespecified and post-hoc analyses of the need for additional therapies, changes in UPDRS scores, and non-motor outcomes. Lancet Neurol, 2011, 10(5): 415-423.
22. Aita JF. Why patients with Parkinson’s disease fall. JAMA, 1982, 247(4): 515-516.
23. Khan I, Jawaid A, Ahmad K, et al. Hip fragility fractures: Anaemia, calcium and vitamin D supplementation. J Pak Med Assoc, 2015, 65(11 Suppl 3): S55-58.
24. No authors listed. Supplementation with vitamin D3 and calcium prevents hip fractures in elderly women. Nutr Rev, 1993, 51(6): 183-185.
25. Prince RL, Devine A, Dhaliwal SS, et al. Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women. Arch Intern Med, 2006, 166(8): 869-875.
26. Eventov I, Moreno M, Geller E, et al. Hip fractures in patients with Parkinson’s syndrome. J Trauma, 1983, 23(2): 98-101.
27. Coughlin L, Templeton J. Hip fractures in patients with Parkinson’s disease. Clin Orthop Relat Res, 1980, (148): 192-195.
28. Turcotte R, Godin C, Duchesne R, et al. Hip fractures and Parkinson’s disease. A clinical review of 94 fractures treated surgically. Clin Orthop Relat Res, 1990, (256): 132-136.
29. Londos E, Nilsson LT, Strömqvist B. Internal fixation of femoral neck fractures in Parkinson’s disease 32 patients followed for 2 years. Acta Orthop Scand, 1989, 60(6): 682-685.
30. Staeheli JW, Frassica FJ, Sim FH. Prosthetic replacement of the femoral head for fracture of the femoral neck in patients who have Parkinson disease. J Bone Joint Surg (Am), 1988, 70(4): 565-568.
31. van den Bekerom MP, Hilverdink EF, Sierevelt IN, et al. A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck: a randomised controlled multicentre trial in patients aged 70 years and over. J Bone Joint Surg (Br), 2010, 92(10): 1422-1428.
32. Keating JF, Grant A, Masson M, et al. Randomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients. J Bone Joint Surg (Am), 2006, 88(2): 249-260.
33. Taylor F, Wright M, Zhu M. Hemiarthroplasty of the hip with and without cement: a randomized clinical trial. J Bone Joint Surg (Am), 2012, 94(7): 577-583.
34. DeWal H, Su E, DiCesare PE. Instability following total hip arthroplasty. Am J Orthop (Belle Mead NJ), 2003, 32(8): 377-382.
35. 庄泽, 曾春, 曾花, 等. 双极人工股骨头治疗老年帕金森患者股骨颈骨折. 中国组织工程研究, 2012, 16(30): 5534-5539.
36. 周义钦, 忻慰, 周琦, 等. 全髋关节置换术治疗髋部疾病合并帕金森病的早期临床评估. 中华关节外科杂志 (电子版), 2014, 8(6): 736-740.
37. 罗文峰, 赵德伟, 王本杰, 等. 双极人工股骨头置换术治疗帕金森患者股骨颈骨折. 中国矫形外科杂志, 2013, 21(10): 1029-1032.
38. Lyell V, Henderson E, Devine M, et al. Assessment and management of fracture risk in patients with Parkinson’s disease. Age & Ageing, 2015, 44(1): 34-41.
39. Agrawal P, Gaba S, Das S, et al. Dynamic hip screw versus proximal femur locking compression plate in intertrochanteric femur fractures (AO 31A1 and 31A2): A prospective randomized study. J Nat Sci Biol Med, 2017, 8(1): 87-93.
40. Zhong B, Zhang Y, Zhang C, et al. A comparison of proximal femoral locking compression plates with dynamic hip screws in extracapsular femoral fractures. Orthop Traumatol Surg Res Otsr, 2014, 100(6): 663-668.
41. Mardani-Kivi M, Mirbolook A, Khajeh Jahromi S, et al. Fixation of intertrochanteric fractures: dynamic hip screw versus locking compression plate. Trauma Mon, 2013, 18(2): 67-70.
42. Dhamangaonkar AC, Joshi D, Goregaonkar AB, et al. Proximal femoral locking plate versus dynamic hip screw for unstable intertrochanteric femoral fractures. J Orthop Surg (Hong Kong), 2013, 21(3): 317-322.
43. Huang SG, Chen B, Zhang Y, et al. Comparison of the clinical effectiveness of PFNA, PFLCP, and DHS in treatment of unstable intertrochanteric femoral fracture. Am J Ther, 2017, 24(6): e659-e666.
44. Jonnes C, Sm S, Najimudeen S. Type Ⅱ intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Arch Bone Jt Surg, 2016, 4(1): 23-28.
45. 张吉斌, 张朝春. 老年股骨粗隆间骨折合并帕金森病患者围手术期治疗. 中国矫形外科杂志, 2011, 19(24): 2058-2060.
46. 李晔, 张保中, 高鹏, 等. 合并帕金森病股骨转子间骨折的手术治疗. 中华骨与关节外科杂志, 2013, 6(4): 361-364.
47. Kim Y, Moon JK, Hwang KT, et al. Cementless bipolar hemiarthroplasty for unstable intertrochanteric fractures in octogenarians. Acta Orthop Traumatol Turc, 2014, 48(4): 424-430.
48. Parker MJ, Anand JK. What is the true mortality of hip fractures? Public Health, 1991, 105(6): 443-446.
49. Burns A, Younger J, Morris J, et al. Outcomes following hip fracture surgery: a 2-year prospective study. Am J Geriatr Psychiatry, 2014, 22(8): 838-844.
50. Yuasa T, Maezawa K, Nozawa M, et al. Surgical outcome for hip fractures in patients with and without Parkinson’s disease. J Orthop Surg, 2013, 21(2): 151-153.
51. Weber M, Cabanela ME, Sim FH, et al. Total hip replacement in patients with Parkinson’s disease. Int Orthop, 2002, 26(2): 66-68.
52. Karadsheh MS, Rodriguez EK, Harris MB, et al. Mortality and revision surgery are increased in patients with Parkinson’s disease and fractures of the femoral neck. Clin Orthop Relat Res, 2015, 473(10): 3272-3279.
53. Jónsson B, Sernbo I, Johnell O. Rehabilitation of hip fracture patients with Parkinson’s Disease. Scand J Rehabil Med, 1995, 27(4): 227-230.
54. Bliemel C, Oberkircher L, Eschbach DA, et al. Impact of Parkinson’s disease on the acute care treatment and medium-term functional outcome in geriatric hip fracture patients. Arch Orthop Trauma Surg, 2015, 135(11): 1519-1526.
55. Enemark M, Midttun M, Winge K. Evaluating outcomes for older patients with Parkinson’s disease or dementia with lewy bodies who have been hospitalised for hip fracture surgery: potential impact of drug administration. Drugs Aging, 2017, 34(5): 387-392.
56. Zuckerman LM. Parkinson’s disease and the orthopaedic patient. J Am Acad Orthop Surg, 2009, 17(1): 48-55.

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